I C U in pain

As the epidural started wearing off, I was moved into ICU. The only instructions I was given was to keep pumping my ankle back and forth pushing the back of my knee down and to keep this up continually while I was awake. I was also on oxygen and told to keep the mask on for the rest of the night. Ruth followed along but was stopped at the door and told that she couldn’t come in until they had me settled. Settled meant that I was wheeled in to my curtained space and left alone. The pain was really starting to come on. I kept asking for help, someone would walk over and explain that I was receiving pain medication through the epidural, just on a more moderate basis than what is used during surgery. I felt a huge pounding in my knee that was growing in intensity. Finally a doctor came over and started listening to my chest with his stethoscope. His English was impossible to understand and was asking me if I had an “arrhythmia?” What did you say? No No, asthma, he said. Do you have asthma? Does it sound like it? I asked. Oh no, he said, this is just a routine question. Stop asking me these ridiculous questions and help me get this pain under control. I was writhing by this time. He saunters away. Finally Ruth shows up and I tell her that my pain is more than I can endure but no one is helping me. She goes in search of help and comes back with this very kind looking male nurse. He gives me a shot through the IV and said that within 20 minutes this should help. Then he hooks me up to a device that administers pain med intravenously on a regular basis. I tried to calm myself down, but still the pain was relentless. I was told to be patient and by the morning I would feel much better. I didn’t believe this, how could one night make a difference in the pain, and in the meantime I was at my limit of endurance. Nothing they gave me was helping. The nurse came in with another shot and finally there was relief. I could feel the calming effect of the narcotic as it washed over me and dulled the mind screwing pain that had me up against the wall. The ICU staff encouraged Ruth to go but she refused. She perched on a chair and stayed at my side. She brought me some ear plugs to soften the sounds of the monitors continuous beeping as well as the sounds of others painful moaning. I was able to drift off in relative peace by now, my body loaded with very strong drugs. She was finally convinced to go and get some sleep, and I slept, much needed rest as the arduous task of healing was at hand.

I awoke early just as Ruth walked in. She found a way to sneak into the ICU ward, sleuth that she is. I was feeling so much better. The intense pain from the night before had abated, and having had a few hours of sleep I felt that I had survived the worst of the ordeal. I was offered juice or breakfast, but all I wanted was a few sips of water. A sweet nurse came in and said she would sponge bathe me. So Ruth left and I submitted to her skilled hands. I lay there while she scrubbed and rinsed my body. I had a catheter and she cleaned this area with betodine. Then she combed my hair and allowed me to brush my teeth. I felt half way human. The hours ticked by. A few Doctor’s were making their rounds and I was told to keep pumping my ankle, this I did faithfully, like a prayer wheel turning and turning so my ankle was pumping back and forth over and over.

Around noon I was told that I was going back to my own hospital room. I was unplugged from all the beeping gadgets. The pain med pump was staying with me along with an oxygen tank. I was wheeled out on my bed, but first I was brought to x-ray. I wasn’t looking forward to having to move out of bed for the x-rays but fortunately they were able to take the necessary pictures without having to get off my bed.

When we got to my room , they wheeled out my former bed and I could stay all tucked in and cozy in the same bed used in ICU. From this point on, for the next 7 days, the hospital and staff did everything possible to aid and care for me in a very kind and professional manner during this first week of recovery.

Surgery India Style

I was awakened on the day of surgery by a sharp pang in my neck. It was a searing pain that kept my neck in spasm throughout the day. There was a bit of unease settling in because of this really. What an auspicious way to start this already dreadful day. The surgery was scheduled to start at 1 pm. But the gurney didn’t arrive until close to 3. Ruth and I spent those pre surgery potentially fretful hours watching the Simpson’s, seeking comic relief. She also rubbed my neck through out the day, helping the pain a great deal.

I really didn’t feel too nervous. I had implicit trust in my surgeon Dr. Sanjay Pai. I made this decision months ago, and now it was time to surrender. I gave Ruth the thumbs up as I was wheeled down to the “theatre”, as the OR is referred to at Wockhardt.

I’ve practiced mindful breathing for many years. At a time like this, it is invaluable. I use my breathe to breathe in God’s love, and then I breathe out God’s love, sharing it with the world. I breathe in God’s healing power, and I breathe out God’s healing power, and so on. So I was fairly calm and positive as I was wheeled through the corridors and down the elevator.

I was changed into a sterile gown and wheeled into the theatre, where it was freezing cold. Here two anesthesiologists attempted to start an IV. They were examining my arm and the small veins I possess. It’s always been a challenge for medical personal to hook me up. The man who seemed to be a student attempted to stick me. It was botched. I thought “great, I’m being used as a practice dummy.” After much discussion he tried again and hit my vein. The next task was to start the epidural. They had me shift to the operating table. It was cold and hard. They had me sit up, opened my back side and sprayed this ice cold aerosol anti bacterial liquid. It was impossible not to shiver. But I was urgently and not too gently admonished to hold perfectly still. The same student attempted to put in my epidural. He found the spot and I felt a huge bolt of pain sore up my spine. I collapsed and was rolled onto my side again none too gently. Oxygen was administered and then another attempt was made to get it in place. This time they found the correct pathway down my spinal column and an immediate sense of numbing was felt running down my legs. I was rolled onto my back where my arms were brought out to each side, crucifixion style; An IV on my left, blood pressure and pulse gauges on my right and heart monitors on my chest. I was asked if I wanted to be sedated so that I’d sleep through the surgery. I assured them that yes indeed put me out for this, especially since as all of this was going on I heard the sound of the saws and drills being tested that were soon to be applied to my very own flesh. I drifted off to sleep

I awoke just as the surgery started. My Dr. Sanjay Pai had not made his presence known to me but I was pretty sure I heard his commanding voice, beyond the screen that was placed between me and the surgical team. In the periphery were the pain guys, who by this time were totally bored and the Dr. sitting closest to me was gently snoring. I heard cell phones ringing and being answered, “hello, yea I’m in surgery, call you later.” Click.

I lay awake during the entire procedure. The sounds of the machinery cutting through my bone tissue, the smell of my flesh and bone being rendered will never be forgotten. At one point I heard Dr. Pai’s voice say “no, that’s not right, we’ll have to do that again.” The surgery seemed to go on forever. My neck and arms were very achy and I attempted to move them around some, seeking a measure of relief. No one, not once, checked in on me or sought in any way to comfort me or administer more medicine so that I could sleep. The thought crossed my mind that these very interesting, brilliant Indian people simply do not possess qualities of empathy or compassion. It’s just not a part of their framework. This surgery was all about my knee being replaced. They were totally tuned into that. My comfort and mental well being were not a priority. And perhaps the fact that I’m a woman and the entire surgical team were men, made it even less a priority that any care be given to my physical and emotional needs.

Finally, I was told that the surgery was just about over and the wound would be stapled. I asked if everything went all right, and I was given a perfunctory affirmative, yes, everything is fine.

Dr. Pai did not address me at this point either. As the dismantling of all the equipment transpired and the various weights I was held down with were removed I became fraught with convulsive shivers. I was so cold. A hose blasting hot air was tucked under my sheet and I clung to this with all of my draining might.

I was wheeled into post op and left entirely alone until Ruth appeared. She had that wild look of fear, fatigue, and fight in her eyes and I knew then that this surgery was as hard on her as on me. By this time it was 6:30, three and a half hours since she had last seen me, and no one was telling her anything either.

She went looking for a Dr. who would impart some information. Finally the older anesthesiologist who had snored through my surgery came over and said that everything went fine.

Indian Exposure

We arrived in Bangalore India around 4 am India time on a 10 hour direct flight out of Heathrow. India is 12 1/2 hours a head of our time in Colorado. Immigration was a breeze but the baggage claim was excruciatingly slow. The three hundred plus weary travelers from our all night flight congregated around the baggage belt that sqealed like a pig and watched, like zombies, as one bag every minute or so presented itself on the belt. Finally our one checked bag appeared. We were waived through customs and proceeded through the gate in search of our driver that Moe promised would be waiting for us. No sooner did we exit the terminal when a young man asked if we were Susan and Ruth. Now that's service! His name is Suhas and is the guest relations officer at Wockhardt Hospital. He came to the airport with a driver at this early hour, 4am, to make certain we were cared for. When our plane arrived he called immigration and got a discription of our clothing. We were quicly in route. He was warm, friendly and graciously fielded our myriad of questions . The dawn was cracking as we made our way through the sprawling and immense city, affording us our first glimpse of India.

Bangalore is a burgeoning city of 12 million. Four years ago it held 8 million so the growth here is far too rapid for infrastructure to keep up with. Bangalore by India standards is a prosperous city, nevertheless many areas of the city are extremely poor. Tons of rubbish and rubble line the streets where many find their homes. We drove through an area with modern high rise office structures. This is the IT capital of India. Many of the jobs outsourced from the US are found here. An hours drive found us in the hospital district, where we drove up to the front doors of Wockhardt. We were escorted to the 7th of the hospitals 8 floors into a large rather inviting hospital room containing two beds, a small fridge, desk with computer, table, two chairs, and private bath. It smelled strongly of moth balls. Suhas gave us his cell number with strict assurance to call him with any questions or concerns. We showered then waited for the tests we had scheduled to transpire.

The paper work was refreshingly minimal. Basically they got my name, marital status, birth date and religion. Being disconnected from any religious organization I left this last question blank. Two different times individual nurses came back and asked me to please verfiy my religion. Not wanting to offend I begrudgingly agreed to state, "Christian." There was an obvious sign of relief emanating from their sweet faces. Dr Sanjay Pai, my venerable surgeon, walked into our room and gave me a quick preview. He stated quite emphatically that I was too young for knee reconstruction as prosthesis only last 10-15 years. I told him about my constant pain and instablility. I've traveled all this way and I want both knees examined with MRI. I was swiftly taken down to x-ray. At this point I was feeling a bit mifted and a little freaked and felt like fleeing the hospital using this time to travel through India and forget this whole medical tourism business. A short itme later I received two MRI's. Blood tests and urine samples were taken and at least three times this first day my blood pressure was measured. In the afternoon Dr. Sanjay Pai returned and stated that the results of the tests revealed both knees arthritic with the left in advanced stage of degeneration. We discussed various prosthesis and it was his opinion that my left knee is certainly bad enough to receive a TKR.

After he left Ruth and I discussed my condition and options. I firmly beleive that surgery is a last option. But my R knee, though not nearly as painful as my L is in pretty bad shape. It tweaks, burns, pops, and gives out on me. This is my opportunity to correct my disability. I've traveled across the globe at great expense, taking the necesary time off work for this trip as will as the lengthy rehabilitaion time. Who knows if and when I'll ever have this opportunity again.

Glimpse of London

We leave for India in the morning. We've been in London for parts of the past two days. It actually feels longer. The flight from Denver was long and we were extremely glad to have a few days off the plane before the next leg.

As the whole world and we now know, London is a most amazing city. Our hotel room is near Heathrow which is many miles from the downtown core. But public transportation is very efficient. The "tube" or subway gets you just about anywhere one wants to go in the city. It's user friendly and utilized by throngs of locals and tourists alike. Yesterday we took and unguided walking tour to Buckingham Palace, Westminster Abbey and Cathedral, St. James Parkway and along the Thames River. The architecture is beyond awe. We were in the presence of over a 1000 years of history. But it's the people watching that is the real kick. What a cosmopolitan arena. People from the entire globe gather to this epic city. And everyone it seemed was having the time of their lives. From the start we noticed just how good natured Londoners are. Before we would even ask for directions someone was offering advice. It didn't take long to find out though that everyone had a different idea of which direction or bus we should take.

People seem so much happier here and in better shape. Of the thousands we observed reveling through the city few were over weight. People were not necesarily super athletic, or pencil thin, but rather quite normal. Fashion rules and the varied attire and wild and chic hair cuts added much to our delight. When Europeans talk about holidays they are referring to the long vacation and travel time workers enjoy every year rather than the orgy of mandatory spending and eating we annually and frantically participate in. Pubs close down here at the reasonable hour of 11pm, not 2am. There are lots of restaurants, but way fewer fast food options. Lovers are everywhere and unabashed in diplaying affection. It seems to be a more casual relaxed way of being that our hurried lifestyle prevents. Faces are softer, quick to smile and engage in interaction. A casual observation reveals a refreshing lightness and a love of life look and feel from the managerie of people congregating in this grand city.

We knew before arriving that London is very expensive. But we didn't expect the hotel to charge extremely high prices for amenities we're not used to paying for, especially when we paid so dearly for our tiny room. Internet service, 10 pounds for a half hour, an extra tea bag? 3 pounds, airport/hotel shuttle which is a ten minute ride/4 pounds each. The exchange rate is the best it's been in years for the US dollar. But it's still $1.70 for each pound.

The news here as everywhere is the devastated world economy. One of the biggest stories is Obama's presidential campaign. The Brits and their papers love him. They predict and hope for a landslide victory and feel his ability to govern and lead will set the States and the interconnected world on a far better course.

Today we slept in until noon. Ahhhh, holidays! Ruth got her hair cut and I got a massage. This evening we saw the theatre production, "Stomp." Percussion created by janitorial tools; brooms, trash cans and lids, match boxes and plastic bags. It was so creative and loads of fun. Everyone left happy and revved. Afterward we found a pub and toasted our farewell to London and the start of our Indian adventure.

Preparations & Posterings

We leave for London and India in two days. We’re packing as light as possible . Our instructions were to bring cotton dresses to India and warmer clothing for our London tour. My lap top is key, a few books and DVD's, camera, chargers, cell phones and a small feather pillow. Comfortable sleep is a priority. Just a few "good luck" charms of polished rock and rose quartz crystal, along with Aura Soma Serapis Bey. We heal through our senses and this elixor bestows our sense of smell of earth's and angels gift to our inner passages.

As the economy in the US reveals the imaginary and decrepit value in which we have placed our trust , we experience moments of wary upon leaving our home soil. What if during our time away this “sucker” goes down. We could be stranded. Our assets could be frozen. Who knows what and on and on.

If things are about to get really rough here, I want two strong legs to walk on. This is one way to achieve that miracle. Ruth is smart, savvy and a true lover of adventure and travel. So we’re going, but of course. In every life there are times when one casts their fate to the winds, surely this is one for me.

Moe, our honorable medical tourist guide, arranged for us to stay at a 5 star resort in Goa. It was horribly expensive, especially by India standards, $700 for four nights including all meals. The Rough guide to Southern India tells us that $10 a night will buy one a sufficient room near the beach. We also want to search out our own special places and meals. His featured resort would totally insulate us from any participation in real travel. So we’re on our own for finding accommodations. Our e-mails have turned up a response from a small inn near the beach, Heaven Goa. They have our reservation.

Becoming Medical Tourists

I tore the ACL in my left knee skiing 32 years ago. I lived with it for 24 years before my right knee crumbled underneath me, leaving me without a strong leg to stand on. I underwent bi lateral ACL reconstruction in 2000. I never healed from the surgery. I developed severe tendonitis from the patella graft that was taken to replace my torn ligaments and my knees have been mush ever since. After my divorce I was paying $550 a month for health insurance. Not only was this a tremendous drain on me financially but the process of filing a claim and getting the insurance to actually pay for medical care was excruciating. I made the decision to give it up. The whole system was actually making me sick. I had no money after paying the monthly premiums for wellness. I knew that once I gave it up I would never again be able to insure my knees. But I bluntly cut myself off from this broken system.

As the years ticked by my knees have continued to erode. I’m 54 now and I can no longer ski, hike, or play any of the outdoor games that entice us to stay active. I have talked with many others who like me have endured the loss of healthy joint tissue and function. Many have undergone the procedure of total knee replacement. Without fail everyone I’ve spoken with has felt that this was the best medical decision ever made. Knee and hip replacement is considered miracles of modern medicine. The success rate is in the high 90% category. But obviously because I don’t have health insurance this procedure is not available to me here.

In my internet surfing I discovered the world of “medical tourism.” I chanced upon an organization called Healthbase. They act as a liaison between patients and doctors from other countries. From the start I felt a sense of comfort and confidence working with Moe, the Healthbase representative in the US. He is from India and now lives in Boston. He became my source of information for doctors and procedures offered across the globe.

We discussed having surgery in Mexico, just across the border from San Diego, as well as in Thailand and India. Cost was definitely a factor in my decision, but of course more than that I wanted the best surgeon and technology available to me. The medical costs of TKR in Mexico / $13,000, Thailand / $9,000, and India /$7,000 per knee. This includes all medical costs including one week of care in the hospital. It does not include costs of travel. The average cost that I could ascertain for this procedure in the US was $38,000, with the average in-hospital stay of 48 hours.

Moe strongly recommended India as the best place for me. His Mother had undergone bilateral TKR there and was greatly improved with the results. Dr. Sanjai Pai who performed his Mother’s TKR was the world class surgeon available to me. His bio is most impressive having worked as an orthopedic surgeon for 20 plus years performing over 3000 joint replacement procedures. He’s also been a forerunner of minimally invasive joint replacements. With the use of a computer that allows pin point accuracy the incision is smaller with less muscle tissue traumatized. Recovery time as well as pain is reduced. All of this sounded convincing to me. My sister Ruth, in her caring and consistent way of supporting me, agreed to join me on this across the world venture into India and surgery.

She loves the adventure of travel. She’s always dreamed of traveling to India. This trip is hardly what she had in mind. But at our age we all have health issues. So being the practical person that she is, decided to use this opportunity to have a serious injury to her cervical spine examined, with the additional possibilities of Lasik surgery, dental work, and a complete physical. My surgery is pretty straight forward but hers is quite unique and specific, frought with alarming consequences. Moe sent us the name of the surgeon he would arrange to meet with Ruth, Dr. Rajakumar. He also has quite an impressive bio. He is renowned in India for his innovation, skill and interest in minimizing the trauma induced with surgery. We both feel confident and excited about what we are about to embark on. There is a sense of liberation and gratitude that there are other possibilities for our own health and welfare as we are so cut off from medical care in our own country.

Our flight is booked with British Airline. There is a direct flight between Denver and Heathrow London; and then a direct flight from London to Bangalore, India. To travel around the globe it just doesn’t get much easier than that. Since neither of us have ever been in London, we opted to spend two nights there for a whirl wind tour of this famous city. This will help to mitigate the extreme jet lag one would expect to encounter for such a lengthy flight. We’re also taking the first five days in India to experience the mystical sea coast of Goa and the palaces and city of Bangalore before mine and possibly Ruth’s daunting surgeries take place. Moe through Healthbase has arranged our entire itinerary. We have rooms at a hotel near Heathrow, a driver when we arrive in Bangalore from the airport to the hospital for the initial consultations, air travel to Goa, transportation to our arranged stay there, transportation back to the airport, with a driver there to take us back to the hospital. The hospitals in Bangalore have rooms large enough to bed the patient as well as a traveling companion. So if Ruth doesn’t become a patient she will stay in my room. They seem to be more than accommodating to those of us who arrive from other countries.